HomeMy WebLinkAboutForm 465 - Police Association PAC (2011-10-22) Supporting Andrew McCulloughSupplemental Independent
Expenditure Report
(Government Code Section 84203,5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded to
whole dollars.
0 Amendment (Explain Below)
I.D. NUMBER (if recipient committee)
1. Committee/Filer Information 831553
COMIMITTEEIFILER'S NAME
San Rafael Police Association Political Action Committee
STREET ADDRESS (NO P.O. BOX)
I520 Fifth Avenue
CITY STATE ZIP CODE AREACODE/PHONE
San Rafael CA, 94901 (415) 485-3000
OPTIONAL: FAX/ E-MAIL ADDRESS
2. Name of Candidate or Measure Supported or Opposed
Report covers period
from 09/25/2011
through 10/22/2011
Date of election if applicable:
(Month, Day, Year)
11/08/2011
Treasurer (if recipient committee)
NAME OF TREASURER
Mr. Scott Ingels
MAILING ADDRESS
1520 Fifth Avenue
SUPPLEMENTAL INDEPENDENT EXPENDITURE
Date StamD �__
Page 1 of__L_
For Official Use Only
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA, 94901 (415) 485-3000
OPTIONAL: FAX/ E-MAIL ADDRESS
CHECKONE
NAME OF CANDIDATE
Andrew McCullough
OFFICE SOUGHT OR HELD AND DISTRICT, IF APPLICABLE
City Council Member City of San Rafael, CA
SUPPORT
X
OPPOSE
NAME OF BALLOT MEASURE
BALLOT NO]LETTER
I JURISDICTION
SUPPORT
OPPOSE
3. Independent Expenditures Made Attach additional information on appropriately labeled continuation sheets.
CUMULATIVE TO DATE
DATE
NAME AND ADDRESS OF PAYEE
DESCRIPTION OF EXPENDITURE
AMOUNT
(JAN. 1 - DEC�31)
Freeman Public Affairs, Inc.
4,648.67
Mailer including production and postage
10/17/2011
1 405 Marcelina Avenue, Suite ill
in support of Andrew McCullough for Sat
13,542,76
Rafael City Council
Torrance, CA 90501
U.S, Postmaster
2,100.00
Postage for mailer in support of Andre u
MEMO
10/17/2011
1433 Marcelina Avenue
McCullough for Sap. Rafael City Council
Subpayment made
through:
Freeman Public
ffairs,
Torrance, CA 90502
Inc,
FPPC Form 465
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)
Supplemental independent Type or print in ink.
Amounts may be rounded
Expenditure Report to whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
San Rafael Police Association Political Action Committee
SUPPLEMENTAL INDEPENDENT EXPENDITURE
Report covers period
from
09/25/2011
of
through 10/22/2011 2 2
Page
LD. NUMBER (If recipient com.)
831553
4. Summary
1. Total independent expenditures of $100 or more made this period. (Part 3.)........................................................................................... $ 4,648.67
2. Total independent expenditures under $100 made this period. Not itemized. 0.00
3. Total independent expenditures made this period (Add Lines 1 + 2.).......................................................................................... TOTAL $ 4,648.67
5. Filing Officers Enter the name and address of each filing officer with whom the filer's most recent campaign statements (Form 450, 460 or 461) have been filed.
1) NAME OF FILING OFFICER 3) NAME OF FILING OFFICER
San Rafael City Clerk
ADDRESS (NO. AND STREET) ADDRESS (NO. AND STREET)
1400 5th Avenue
CITY STATE ZIP CODE
San Rafael, CA 94901
2) NAME OF FILING OFFICER
ADDRESS
(NO. AND STREET)
CITY STATE ZIP CODE
r�i7
4) NAME OF FILING OFFICER
ADDRESS (NO. AND STREET)
CITY
6. Verification
1 have used all reasonable diligence in preparing and reviewing this statement and to the best of my
penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on By
DATE
Executed on
DATE
Executed on
DATE
Executed on
DATE
STATE ZIP CODE
STATE ZIP CODE
the information contained herein is true and complete. I certify under
TREASURER OR ASSISTANT TREASURER
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT, OR RESPONSIBLE OFFICER OF SPONSOR
By
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
FPPC Form 465
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)